The 2027 Renewal

The 2027 Renewal Prep Checklist for Self-Funded Employers (200 to 2,000 Employees)

If you run benefits for a company between 200 and 2,000 employees, you already know the thing nobody outside your role quite gets: you carry one of the organization's largest line items, with a fraction of the support the job deserves, and the year's biggest decision arrives on someone else's calendar.

The renewal package lands in the fall. By then, most of what shaped it has already happened. The work that determines whether you walk into renewal prepared or reactive is the work you do now, in the summer, while there's still time to change the outcome.

This is the checklist I'd run between now and open enrollment. None of it is sophisticated. It's sequenced, it's honest about what's hard, and it's built for a team that doesn't have a department of twelve to lean on. Think of it as the order to work in, not a list of everything you could theoretically do.

First, a word on timing

Renewal feels like an event that happens to you in November. It's actually a season that starts in July. Your carrier, your PBM, and your stop-loss underwriter are pricing next year right now, off your claims and trend from this year. The numbers aren't a surprise waiting to be revealed in the fall. They're a story your data is already telling, if you read it in time.

So the whole point of starting in the summer is simple: it's the window where you can still act on what you see, instead of explaining it after the fact. Ninety days is enough to prepare. The renewal package is not.

Phase 1 — Gather (the first three weeks)

Before anyone hands you their version of your year, pull your own. You want your own read of the plan, not instead of the renewal, but ahead of it.

Gather: claims and trend, year-to-date, against budget; your top cost drivers, by category (medical, specialty, pharmacy); large-claim activity, including anything tracking toward your stop-loss threshold; pharmacy and specialty spend, broken out (GLP-1s are now the top-named Rx cost driver for a majority of employers, so look here specifically); last year's stop-loss terms (your deductible, any lasers, the rate and the cap); and the plan changes you made last year, with the dates they took effect.

The goal of this phase isn't analysis yet. It's making sure that when the renewal arrives, you already know your own numbers well enough to challenge anyone else's.

Phase 2 — Read (weeks three to five)

Now find the story, not just the total. A renewal package will give you a number. Your job is to know why that number is what it is, because that's the part you'll be asked to defend.

Work through what's actually driving the trend (one or two large claims, a pharmacy shift, or broad utilization); whether last year's plan changes did what you hoped (if you raised a deductible or added a program, did spend actually move, or did it just shift); and the question your CFO will ask first: "Why are we off budget?" If you can't answer that with the drivers named, that's the gap to close before renewal, not during it.

This is the phase the job rarely leaves time for, because so much of the summer gets eaten by the gathering in Phase 1, where you log into four systems to reconstruct one picture. That assembly burden is real, and it's worth naming, because it's usually the reason the reading doesn't get done. If you protect time for anything, protect it for this.

Phase 3 — Ask (weeks five to eight)

Bring questions to your advisor, not just your inbox. A prepared question turns a status update into a strategy conversation, and it makes your advisor a sharper partner. The relationship works best when you arrive knowing your own numbers.

The questions worth asking: what's driving our renewal, line by line, and what's within our control; what did our interventions actually return last year; what are our stop-loss options, and what would change our terms; and what are you seeing across your other clients that we should be thinking about.

You're not outsourcing the thinking here. You're raising the bar on the conversation, which is exactly what a good advisor wants you to do.

Phase 4 — Decide, in order (weeks eight to eleven)

There are three big decisions to lock before open enrollment, and the order matters, because each one depends on the one before it.

1. Stop-loss structure, first. This sets the risk your plan is carrying, and everything else is priced against it. With average stop-loss premiums up 12.7% in 2026 (Segal, across 225 plans, up from 9.7% the prior year), this is not a renewal to rubber-stamp. Test the market with an RFP, compare contract terms rather than headline rates, and decide whether a no-new-laser guarantee is worth paying for. For a mid-market plan, the predictability often is. Lock this first.

2. Pharmacy and GLP-1 posture, second. Once you know your risk structure, decide your pharmacy levers. Prior authorization, indication carve-outs, formulary tiers. GLP-1 coverage is the live one. A growing share of employers are now pulling or restricting coverage for cost reasons, but dropping it is the blunt lever. The harder, more honest question is whether dropping actually saves money net of the comorbidity costs you keep, and whether you'll be able to measure that. Whatever you decide, decide it as a measured choice you can defend, not a reflex.

3. Plan-design changes, third. Deductibles, copays, network structure. These come last because they interact with both decisions above, and because the easy lever (shifting cost to employees) can quietly backfire if people skip care you'll pay for later. You only see that backfire if you read the claims after the change.

Phase 5 — Confirm it got done (weeks eleven to thirteen)

The decisions only count if they actually happen and you can tell whether they worked. This last phase is the one most often skipped, and it's where preparation becomes accountability.

Communicate the changes to employees clearly and early. Confirm every decision is reflected in the plan document, not just agreed in a meeting, but executed. And set the one or two numbers you'll watch next year to know whether each decision did what you intended: large-claim activity for stop-loss, net pharmacy spend for your GLP-1 posture, utilization for any plan-design change.

That last step is the difference between making a decision and knowing whether it was the right one. A year from now, when you're prepping the 2028 renewal, those are the numbers that tell you what to repeat and what to fix.

A note on what this is really about

A quick illustration of why the order matters. (The figures below are illustrative, to show the dependency, not drawn from any specific plan.) Say a mid-market plan locks its plan design in August to hit a budget target, then runs its stop-loss RFP in September and finds a structure that changes its risk exposure. Now the plan design was set against the wrong assumptions, and there's no time left to revisit it. Sequence first, decide second. That's the whole reason the phases run in this order.

None of this requires a bigger team. It requires a head start and a way to read your own data in time to use it. The hard part of this job has never really been the deciding. You already know how to make these calls. The hard part is getting to the decision through the gathering, the four portals, and the report that arrives too late to act on.

The best version of renewal prep is one where the assembly is already done when you sit down, your advisor is a genuine strategic partner in the room, and your time goes to the decisions instead of the spreadsheet. That version is worth building toward.

If you're starting your prep this summer and any of this maps to where you're stuck, it's a fair conversation to have. The window is open now, and it narrows every week the renewal gets closer.